Loe raamatut: «One Night in Emergency»

CHAPTER ONE

‘THERE’S been a bus crash!’

Eleanor’s heart didn’t sink as Mary Byrne placed her hand over the telephone receiver and mouthed the words to the rapidly gathering staff. Instead, it skipped into overdrive, galloping along way too fast.

Her mind was going at the same speed, too.

It was Saturday night and the emergency room was already full to bursting. Half the staff had rung in sick, courtesy of a flu bug that had started in Singapore and had somehow landed in Melbourne five days previously, so the place was being manned by only a couple of regular staff, along with rather too many agency nurses. And to cap it off, it was Eleanor’s first night duty in the emergency department of Melbourne Central.

Actually, it was her first shift in Melbourne Central, full stop. She’d rather been hoping for a gentle easing into her new job, a slow introduction to a city emergency department after completing her training and graduation year in the country, but given that Mary Byrne was her mentor for the next three months it meant that for the most part they would be sharing the same shifts.

And as Mary had volunteered for a week of nights, by default, so too had Eleanor.

‘A minibus crash,’ Mary corrected, with a relieved sigh as she hung up the telephone and came over to address her staff. ‘Which is a lot better than it first sounded, but that still means we’ve got twelve new patients arriving and at this stage we’re not sure of the injuries. Ambulance Control is going to let me know more just as soon as they do.’

The red phone buzzed again and Mary answered it promptly, her stern face rigid with concentration and her thick Irish brogue direct and to the point.

‘Lord help us all, then!’ she exclaimed, slamming down the phone and coming back to her team.

‘What is it?’ Vicki, one of the few regular staff in the unit tonight, asked as Mary rolled her eyes and muttered loudly under her breath. ‘Does it sound serious?’

‘Oh, it’s serious all right,’ Mary retorted. ‘The minibus that crashed happens to be filled with half the victors of some local rugby shield match. And, as luck would have it, the other half of the team was following behind, so no doubt they’ll be descending on us too just to make things a touch livelier.’

‘Where have you been, young man?’ Mary asked as Pier, one of the agency nurses, joined the team. ‘When the red phone goes off, you’re supposed to come directly over.’

‘Oui, I know, but I was putting cubicle six on a bedpan.’

‘When the red phone buzzes, you ensure your patient’s safety and then come to the nurses’ station.’ Mary fixed him with a stern glare. ‘The only exception to that rule is if you’re in Resus with a critical patient.’

‘Are the injuries bad?’ It was the first time Eleanor had spoken, her very newly registered nurse brain whirring ahead of itself, trying to imagine the types of injuries that would be arriving. For a full year she’d been desperate to roll her sleeves up and tackle some real emergency nursing, constantly frustrated by her previous manager’s attempts to thwart her, but now that the moment appeared to have arrived, suddenly Eleanor felt woefully unprepared.

‘Cuts and bruises at this stage, one or two sound as if they may have fractures, and the driver has a nasty seat-belt injury—injuries I can deal with blindfolded,’ Mary thundered on. ‘It’s twenty-four young men with too much C2H50H on board I can well do without.’

‘C2H…’ Eleanor frowned, her voice trailing off as she tried to, first, remember to look assertive and, second, to work out just what on earth Mary was going on about now.

‘You don’t write that on their notes, mind,’ Mary said sharply as Eleanor dutifully wrote the mass of letters and numbers down. ‘They can smell like a brewery, have slurred speech and be staggering as they walk, but it would be very dangerous to make any assumptions. The symptoms are the same as a head injury and it won’t go down too well in court if it’s even been hinted at in the patient notes. Have I made myself clear?’

Eleanor nodded, but her frown remained.

‘Now Resus is already full, so I’m going to head in there and give Dr Heel a hand to clear the place. Caitlin is on triage…’

‘Helen, one of the agency nurses, has got an ICU certificate,’ Vicki ventured. ‘Why don’t you take her into Resus with you? Heather and I can manage the trolleys. And I’m sure Pier will be OK doing the cubicles.’

The look that Mary shot Pier told everyone present that Mary was yet to be convinced. Pier might be divine to look at, might be incredibly eager to please, but the fact his English was heavily laced with a thick French accent was already causing more than a few problems.

‘Sounds good.’ Mary nodded. ‘The rest of you will have to pitch in.’ Her eyes again turned sharply to Eleanor.

‘You did some Emergency in your grad year, didn’t you?’

‘I did,’ Eleanor gulped, ‘but it was a tiny country hospital, I wouldn’t exactly call myself—’

‘They have bandages in the country I presume?’ Mary broke in, and Eleanor nodded nervously.

‘Then you can have the walking wounded with Pier. Patch them up and move them on. And, for goodness’ sake, once they’re seen, do your best to get them into a taxi and as far from here as possible. I do not want my waiting room pumping with renditions of ‘‘Swing Low Sweet Chariot’’ or ‘‘Danny Boy’’.’

‘We’re in Australia, Mary,’ Vicki pointed out with a grin. ‘It’s ‘‘Waltzing Matilda’’ here.’

‘I don’t need a song sheet,’ Mary barked. ‘Just get them treated and home to their mothers. Poor women!’

‘Right.’ She clapped her hands together. ‘The first will be here in fifteen minutes or so which gives us time to do a quick clear up and get the place ready. Now, do we all know where we’re supposed to be?’

Everyone nodded and started to drift off to their assigned tasks. Everyone except Eleanor. She didn’t want to ask stupid questions, didn’t want to take up Mary’s valuable time, but given she’d been so specific about not writing in their notes, Eleanor had no choice but to ask exactly what it was she couldn’t write.

‘Mary, sorry to be a pain, it’s just that I didn’t understand what you meant when you said…’ Eleanor swallowed hard, beating back a blush as the dispersing crowd all stopped, then turned to hear her question. ‘What exactly is C2H…?’ She glanced down at the scrap of paper in her hand where she’d hastily written the jumble of letters. ‘C2H5OH?’

‘Oh.’ Mary gave her a very nice smile, which Eleanor was sure was false. ‘I’m sorry, Eleanor, did I not explain myself clearly enough for you? I should have said that it’s the chemical equation for ethanol.’

‘Ethanol?’ Eleanor repeated, the question in her voice evident, her bewildered eyes looking back up to Mary.

‘It means drunk, Eleanor,’ Mary said through strained lips. ‘Does that make things clearer for you?’

‘Much,’ Eleanor replied, blushing to the roots of her hair.

‘So take no nonsense from any of them,’ Mary warned. ‘A pretty thing like you will be like a sitting duck.’

* * *

‘What’s wrong?’ Pier asked as they headed for the cubicles, noticing Eleanor’s grimly set face. ‘I also did not know that was the chemical equation for alcohol.’

‘It’s not that,’ Eleanor retorted, shaking her head and marching on as Pier struggled to keep up.

‘Then what ever is the matter with you all of a sudden?’ Pier asked, clearly perplexed. ‘The accident is not as serious as we first thought, we will all manage.’

‘I know we will. It’s not that, it’s what Mary said about…’ Eleanor shook her head angrily. ‘It doesn’t matter.’ But the French clearly weren’t fazed by a dash of emotion and Pier just followed her into the four-bedded treatment area, patiently waiting as Eleanor pulled a blanket around the shoulders of an elderly lady.

‘What did she say that has you so angry? And you are angry, Eleanor,’ Pier pointed out, watching as she stripped a case of a pillow, then rammed the unsuspecting foam rectangle into a fresh pillowcase.

‘Well, so would you be.’ Her eyes flashed as she spoke, two spots of colour burning on her cheeks. ‘What on earth do my looks have to do with anything? Two hours into my first shift and the charge nurse is making little jabs about me being pretty.’

‘But you are pretty,’ Pier exclaimed. ‘Beautiful even! Blond hair, blue eyes, a very feminine shape.’ He made a rather lewd hourglass gesture with his hands, but somehow Pier could get away with it without causing offence. ‘In fact, if I went for women, I would definitely go for you.’ He watched as her lips tightened. ‘I am not making things better, no?’

‘No,’ Eleanor replied, as they stripped the linen off a trolley and started to remake it in preparation for the new set of patients. ‘Mary wasn’t paying me a compliment, Pier, believe me. I’ve been up against a few ‘‘Marys’’ in my training and grad year and they all assume that a blond-haired, blue-eyed nurse can only be after one thing.’

‘Sex?’

‘A husband,’ Eleanor wailed, thumping him none too gently with the pillow. ‘They all assume I’m merely biding my time until some suitable rich and good-looking man comes along.’

‘We all are.’ Pier grinned then, realising humour wasn’t called for here, he stared at her thoughtfully for a long moment.

Eleanor wasn’t just pretty, she was seriously beautiful. China-blue eyes heavily framed with dark lashes were an absolute contrast to the thick blond hair, which, unless she went to the hairdresser’s weekly, was for once natural—all set off with a deep red rosebud mouth in a clear-skinned face and, given that Pier was rather more in tune with his feminine side than most men, he finally saw her problem.

‘Eleanor, people can be jealous, say cruel things, make silly assumptions, pigeonhole you for how you look, how you talk, the job you do even. But you have to learn to let those hurtful comments go. Once you learn to be confident in who you are and what it is you want from life, those bitchy comments will just wash over you. Believe me, I know.’

Something in his voice reached Eleanor, something in Pier’s stance told her that as happy and confident as he appeared life hadn’t always been easy for him, and she gave a dejected nod. Pier’s sympathetic advice and surprising understanding was all she needed to open up a touch.

‘I didn’t do too well in my grad year, that’s why I finally made the decision to leave my home town and came here to get some experience.’

‘You were in the country, oui?’

Eleanor nodded. ‘The manager didn’t like me—in fact, that’s a massive understatement. Rita actively disliked me and in a tiny country hospital there aren’t too many places to hide.’

‘How small was it?’

‘Three wards and a tiny emergency department, but when I say emergency it was more of a GP unit. Any real emergencies were transferred to the city.’

‘So you do not have much experience in emergency nursing.’

‘I would have had,’ Eleanor said darkly, ‘if only Rita had let me within a square mile of the place. Even though it was a tiny hospital, we covered a vast area. There were a lot of farming accidents, heart attacks, even a few suicide attempts. Of course, they were moved on to the city once they were stabilised, but until the paramedics arrived they were treated at the hospital. If Rita had only let me in a bit, I’d have had a lot of experience by now.’ Eleanor gave a tight shrug. ‘She treated me as if I’d barely got my first Guide badge, let alone a nursing degree. I spent my whole time in my so-called emergency rotation giving tetanus shots, putting on slings and bandages and making cups of tea for relatives. If I hadn’t worked the wards for six months I’d have come out of my grad year none the wiser than when I’d started. I had to tell them at my interview, of course. They assumed I had some emergency experience, but when I told them how little I’d really done it was decided that I’d be rostered on with Mary for the next few months. If I last,’ Eleanor added. ‘She seems so fierce.’

‘She needs to be, I guess. Imagine if this minibus crash had turned out to be really serious.’

‘I suppose. And I know that I’m not much help at the moment, but I’m not completely useless. I might not be a great emergency nurse yet, but I have spent the last year working. It mightn’t have been a busy teaching hospital, but we still had sick patients. I mightn’t have learnt a lot in emergency but it was a different story on the wards. The country’s crying out for nursing staff. Towards the end of my grad year I was even in charge of some shifts on the wards, yet Mary seems intent on treating me as if I’m a complete novice. At the interview she seemed so nice…’

‘She is nice,’ Pier broke in, smiling at Eleanor’s dubious expression. ‘Emergency nurses are a funny lot. ICU and coronary-care nurses are the same—cliquey, bitchy, always thinking that they’re the busiest, most understaffed unit in the whole hospital.’ As Eleanor’s frown deepened, Pier’s smile widened. ‘But they’re also the funniest, most down-to-earth, loyal lot you’ll ever hope to meet, and once you’re in you’ll be there for life. You’ll end up being Mary’s biggest fan, I bet.’

‘I doubt it,’ Eleanor scoffed. ‘And how come you’re such a fan, when all she’s done is roar at you?’

‘She’s testing me,’ Pier responded easily. ‘I guarantee if I make it through this shift, by the morning she’ll be giving me the pick of the unfilled shifts on the roster. But I still don’t understand,’ Pier moaned, unfortunately getting back to the one subject Eleanor wanted to avoid. ‘Why didn’t this manager like you?’

‘Well, in my written report Rita said that I wasn’t assertive enough, that I was too busy focusing on petty details and not getting the job done.’

‘What sort of details?’

Eleanor shrugged. ‘Take Agnes over there.’ She gestured to the elderly woman, who was sitting up now, her dirty feet sticking out from the blanket, her worldly goods wrapped in two carrier bags under the trolley.

‘Can I have a bedpan, love? No hurry.’

‘All night I give bedpans.’ Pier rolled his eyes, ducking out and coming back two minutes later as they both helped the elderly woman on and waited outside the curtain. ‘All night I tell you. You were saying?’

‘My manager would have sent her off into the night, whereas I…’

‘Would have let her sleep?’ Pier ventured.

‘And I’d have probably tried to arrange a social work referral for the morning, but Rita hated it. She said that I was slow, not good at finishing a job, that I left the place in a mess after I’d done a shift. But I didn’t come into nursing just to check drugs and drips. I want to get to know my patients, to make a difference.’

Pier gave a knowing nod. ‘It can be a bit like that sometimes. But what has all this got to do with you being pretty?’

Eleanor didn’t want to go there, didn’t really want to rake over old ground, but there was something about a night shift, something about sharing twelve hours with a virtual stranger you might never see again, and definitely something about Pier that made her open up. ‘Apparently I hid behind it.’ When Pier didn’t respond she elaborated further. ‘I’d bat my eyelashes to get my own way. Make a mess of things and then apologise, and apparently because I flashed a bit of cleavage all was forgiven.’

‘You flashed your cleavage?’ Pier’s eyes were aghast.

‘No.’ Eleanor found she was smiling. ‘It rather tended to flash itself. We had to wear baggy old theatre gear and the neckline wasn’t exactly tailored. Well, I heard Rita saying that I used my…’ Stumbling over the word, she was infinitely grateful when Pier chose a better one.

‘Assets?’

‘Thank you. I heard Rita implying that I used my assets to gloss over the fact I was a lousy nurse.’

‘She sounds horrible,’ Pier stated loudly. ‘Horrible and ugly, too, I bet?’

‘She was actually,’ Eleanor admitted. ‘But without her on my side I wasn’t going to get anywhere. I really want to be an emergency nurse, Pier, it’s all I’ve ever wanted to be. That’s why I decided to cut my losses and move to the city.’

‘So it didn’t help when the charge nurse brought up your ravishing looks the first night you were here?’ Pier asked perceptively, a smile twitching on his lips. ‘Don’t tell me, you want to be taken seriously—isn’t that what all the models say?’

‘I’d settle for being thought of as a good nurse.’

‘Then be a good nurse,’ Pier said simply.

‘Finished, love.’

They helped Agnes off, and then headed to the pan room, the blue lights of the ambulance flashing past the window as the first of the minibus accident casualties arrived. ‘We’d better get out there.’

Eleanor gave a watery smile. ‘Thanks, Pier, thanks for listening.’

‘Any time,’ Pier said airily. ‘If I can think of anything you can do to improve things, I will tell you on our meal break. I am good at advice.’

‘So am I.’ Eleanor grinned as they headed across the unit. ‘So here’s some—if you don’t want to be giving out bedpans all night, trying saying yes instead of oui!’ She looked at his bemused expression. ‘You’re sending out subliminal messages, Pier. Every time one of the old ducks hears you say wee, they ask for a pan!’

‘You really aren’t just a pretty face after all!’

‘No, Pier,’ Eleanor turned her blue eyes on her new friend and fixed him with a determined glare. ‘And I intend to prove it.’

* * *

As Mary had predicted, the arrival of the rugby team certainly livened the place up, not that it had been quiet before. But once the ambulances started arriving, in no time at all every cubicle, every trolley and every chair was packed to capacity, with staff rushing between them, prioritising patients, commencing treatments, pagers buzzing like unattended alarm clocks as the phones rang ever on. But somehow it was controlled chaos, a team stretched to its limits yet performing impeccably under Mary’s fierce guidance, and for Eleanor, although busy, although more rushed than she’d ever been in her rather short nursing life, it was a night for falling head over heels in love with Emergency.

Real Emergency.

A team working independently at times, but always looking out for each other.

Monitors bleeping, blue lights flashing past, paramedics racing in, even Jim the porter providing invaluable back-up, wheeling patient after patient around to X-Ray, while quietly, in his own unobtrusive way, guiding the junior and new staff, taking Eleanor gently aside time and again and pointing out that Mary preferred portable drip stands to be secured to the trolleys, not IV poles pushed alongside them, that in an unexpected emergency it made transportation easier and that maybe she should give the nebuliser the doctor had just ordered before he wheeled the patient up to the ward.

His advice was invaluable and Eleanor took it with a grateful murmur of thanks, the clock whirring past midnight for the most part unnoticed, the waiting room gradually emptying as they worked their way diligently through the night.

‘I’d like a hand in here, please, Eleanor!’ Mary’s flushed face appeared from the Resus doors. ‘I need you to hold an arm for me.’

Which surely couldn’t be as bad as it sounded!

Entering the hallowed area of Resus, Eleanor longed there and then for a day when this room was familiar to her, when she, like Mary, could glance at the wiggly lines on the monitor with a knowing eye and know, just know, that the patient hadn’t gone into cardiac arrhythmia but instead the red dot attaching the electrode to the patient’s chest must have fallen off.

‘Mr Papadopoulos has had an inferior myocardial infarction. He’s supposed to be going up to Coronary Care now, but he’s not well enough to be moved.’

He certainly didn’t look well enough! His eyes were closed as he struggled just to breathe, a grey, clammy face exhausted against the pillow, and Eleanor stepped forward nervously, unsure what she should do, but Mary didn’t keep her in suspense for very long.

‘I want you to shave his chest and reattach the dots,’ Mary ordered, handing Eleanor the clippers. ‘His drip has just packed in and I need to get IV access quickly.’

With shaking hands Eleanor did as asked, listening intently as Mary told her to rub the skin with alcohol swabs before applying the dots. ‘They’ll stick better,’ she explained, turning her attention back to the useless IV bung she was trying to remove before inserting a new one.

‘Heaven help us, do they teach these doctors nothing in medical school?’ Pulling back the sticky plaster on the man’s arm, she tutted away. ‘Can you ever imagine putting sticky plaster on a man and not shaving him first? I’m sorry, Mr Papadopoulos, so very sorry, dear, but I really need to get this tape off.

‘Now, Eleanor, hold his arm for me while I put another IV in and see how I shave the area before I put a wad of tape on. It might seem like a small detail but when Mr Papadopoulos is ready to have his IV removed, you can be sure he’ll thank us for our foresight.’

‘I’ll remember.’ Eleanor nodded. ‘Is there anything else you need?’

‘Could you ask Vicki to come and check some morphine for me?’

Which shouldn’t have been a problem, but instantly Eleanor felt relegated. She was more than capable of checking controlled drugs, it was part of her job, but yet again Mary seemed intent on treating her like a student. ‘I can check morphine, Mary,’ Eleanor pointed out, quietly grinding her teeth as Mary effectively dismissed her.

‘Just ask Vicki to come in, would you? You get on with emptying those cubicles. How is it going out there?’

‘It’s settling. Just a few more to be patched up and sent home.’

‘Good lass.’ Mary nodded. ‘Save cubicle one for me, mind. I’ll come and see him when I’m done in here. If you could just find Vicki for me and ask her to come in, that would be grand.’

‘We’re nearly there.’ Pier gave a tired smile as Eleanor came out. ‘I must have a drink or you’ll be treating me for a faint. Vicki said to sort out our breaks between us—do you want to go first?’

‘You go,’ Eleanor offered, knowing Pier was just being polite. ‘I’ll just finish up here.’

‘There’s nothing to do.’ Pier shrugged. ‘Everything is under control. Mary said to leave cubicle one for her—he just needs some strapping and a tetanus injection, which I’ve already pulled up. Agnes is just sleeping it off in between asking for bedpans and the toddler in cubicle two just needs the doctor to listen to his chest now that his nebuliser is finished, then hopefully his parents can take him home.’

‘Then go.’ Eleanor grinned. ‘Even I can manage that lot.’

It felt strange, being left alone in the department. Not that she was really alone, there were a few patients still around, a few doctors writing their notes up at the desk and the rest of the staff were bobbing in and out of various cubicles. But, standing at the nurses’ station, Eleanor couldn’t help but feel a bit smugly important, as well as nervous in case anything should come flying through the doors and she would, temporarily at least, be the one to deal with it.

‘How much longer will he have to wait?’ A ruddy-faced rugby player popped his head around the curtain and Eleanor made her way over, pulling out the casualty card from the clipboard.

‘Shouldn’t be long.’ Eleanor peered at the card. ‘He just needs some strapping and a tetanus shot.’

She expected an argument, after all she was just standing there, but instead the man disappeared behind the curtain and Eleanor listened with increasing impatience as the drunken guffaws got louder.

‘How long will the doctor be?’ The father of the toddler in cubicle two came over, a worried frown on his face, and Eleanor gave a sympathetic smile.

‘Not too much longer. It has to be a registrar or consultant that discharges Marcus, and unfortunately they’re both stuck in Resus at the moment. They know that you’re waiting, though.’

‘Fair enough.’ He gave a tired shrug. ‘He’s just getting upset with all the noise, you know.’ He nodded pointedly towards cubicle one.

‘I do know,’ Eleanor said grimly. She was about to tell him it shouldn’t be much longer again, about to run with the usual spiel, but Pier’s words had struck a chord.

Then be a good nurse.

Mary was just trying to share the workload by telling them to save cubicle one for her. Eleanor could just picture the scathing look if she came out of Resus and saw her standing at the nurses’ station, twiddling her thumbs when there was still work to be done. Well, she’d learnt her lesson the hard way with Rita. By the time Mary came out, there wouldn’t be a patient in the department and she’d have started cleaning the trolleys. Picking up the kidney dish with the tetanus shot in it, she smiled at Marcus’s father. ‘Leave it to me.’

Breezing into the cubicle, she shot her most withering stare at the five men standing around the trolley. ‘Would you mind keeping the noise down, guys? We’ve got a young child next door and your noise is upsetting him.’

‘Sorry!’ The sarcastic response from the ruddy-faced man Eleanor could deal with, but when the other hangers-on started wolf-whistling Eleanor began to understand why Mary might have dealt with it better. But just as she started to wonder if perhaps she should leave the job to Mary after all, she found a rather surprising ally in her patient.

‘Cut it out, guys.’ His voice was deep and firm and brought an instant response, his five teammates instantly cutting the wisecracks and offering their apologies. For the first time Eleanor looked at her patient.

Then looked again!

For the past couple of hours she’d remained indifferent to the sight of six-foot-four, thick-necked, broken-nosed rugby players, but only a general anaesthetic could have rendered her indifferent to this one.

He was so huge that he made the gurney look like it belonged in the paediatric bay, yet there wasn’t an ounce of fat on his solid frame that was way too big for the white hospital gown that stretched over his wide chest, blond tousled hair framed a rugged face and somehow he even managed to make the customary broken nose look endearing, but, then, one couldn’t linger too long on his broken nose when navy eyes were attempting to focus. ‘Sorry about this,’ he said, gesturing to his raucous friends. ‘They’re getting bored.’

‘Which would be understandable if they were two years old,’ Eleanor replied crisply, determined not to let him see he was having the remotest effect on her. But her bossy nurse routine only delighted the crowd, the cat calls starting up again, growing ever louder, the whistles more piercing as Eleanor’s blush darkened. But when little Marcus in the next cubicle started crying again, Eleanor’s patience finally snapped. ‘Right, you can all wait outside while I fix up…’ She glanced at the casualty card. ‘Mr Hunter.’

‘Rory,’ her patient offered, but Eleanor wasn’t really listening. In best assertive nurse mode she shooed the last of the stragglers in the vague direction of the waiting room.

‘I thought Mary was going to come and patch me up,’ Rory ventured once they were alone.

‘Sister Byrne is busy with a sick patient in Resus,’ Eleanor answered crisply, ‘so you’ll have to make do with me.’

‘That’s fine,’ he responded easily. ‘And you are?’

‘Sister Lewis.’

He was squinting at the name badge hanging around her neck, or at least Eleanor hoped that was what he was attempting to focus on.

‘Do you have a first name?’

‘Sister Lewis will do just fine,’ Eleanor replied firmly. ‘Now, you’ve already been stitched up.’ Peering at the notes, she put them down before turning to her patient. ‘It’s the left thigh, isn’t it?’

‘I hope so, given that’s the one they stitched.’ Lifting his gown, he pulled back the dressing before, annoyingly—extremely annoyingly, in fact—reaching over to the silver trolley beside the gurney and helping himself to a wad of gauze.